Outside of intensive care units (ICUs), central venous catheter-associated bloodstream infections (CVC-ABSIs)' epidemiology and the results of strategies for their prevention are not well known. The aim of the study by García-Rodríguez, et al. (2013) was to investigate the epidemiology and the impact of a multifaceted bundle approach in controlling CVC-ABSIs outside of the ICU.
From 1991 the researchers performed prevalence studies of device and parenteral nutrition use, and prospective surveillance of all episodes of CVC-ABSIs in a 350-bed teaching hospital. CVC-ABSIs incidence/1,000 inpatient-days was calculated. An estimated CVC-ABSIs incidence/1,000 catheter-days was calculated based on the prevalence rates of catheter use and the total number of inpatient-days in each year.
In November 2008, an education program was instituted for care of catheter lines -- reinforcing instructions in aseptic insertion technique, after care and handwashing -- in order to assess the adherence to these measures the quantity of alcohol-based hand-rub consumption/1,000 patient-days was quoted in liters.
In January 2009, a checklist intervention for CVC insertion in ICU was started: hand hygiene, using full barrier precautions, cleaning the skin with alcoholic chlorhexidine, avoiding femoral access and removing unnecessary catheters. Compliance with the central line insertion checklist was measured by real-time audits and was achieved in 80 percent of cases.
Prevalence of use of CVC and parenteral nutrition was similar throughout the study. The researchers followed up on 309 CVC-ABSIs cases. Estimated CVC-ABSIs rate progressively increased to 15.1/1,000 catheter-days in 2008 (0.36/1,000 inpatient-days). After the intervention, the alcohol-based hand-rub consumption increased slightly and estimated CVC-ABSIs rate fell to 10.1 /1,000 catheter-days in last three years (0.19/1,000 inpatient-days), showing a 32.9 percent decrease. The infection rates achieved were lower in internal medicine wards: decreased from 14.1/1,000 catheter-days (0.17/patient-days) in 2008 to 5.2/1,000 catheter-days (0.05/1,000 inpatient-days) in last three years, showing a 63.1 percent decrease. In 2009, the estimated CVC-ABSIs incidence rate was significantly lower in the Internal Medicine ward compared to the Surgery ward: rate ratio (RR) = 0.14, 95%CI: 0.03-0.60), and within the Internal Medicine ward, the estimated CVC-ABSIs incidence rate was significantly lower in 2009 compared to 2008 (RR = 0.20, 95% CI: 0.04-0.91).
The researchers conclude that the rate of CVC-ABSIs increased outside of the ICU, and the implementation of a multifaceted infection control program decreased their clinical impact. Their research was published in BMC Infectious Diseases.
Reference: García-Rodríguez JF, et al. Epidemiology and impact of a multifaceted approach in controlling central venous catheter-associated blood stream infections outside the intensive care unit. BMC Infectious Diseases 2013, 13:445 doi:10.1186/1471-2334-13-445